Post-traumatic headache pathophysiology in paediatric concussion: A systematic review

Feiven Fan; Vicki Anderson; Thilanka Morawakage; Noor Khan; Jesse S Shapiro; Vera Ignjatovic; Michael Takagi

doi:10.1016/j.neubiorev.2023.105498

Post-traumatic headache pathophysiology in paediatric concussion: A systematic review

Neurosci Biobehav Rev. 2024 Jan:156:105498. doi: 10.1016/j.neubiorev.2023.105498. Epub 2023 Dec 2.

Authors

Feiven Fan¹, Vicki Anderson², Thilanka Morawakage³, Noor Khan⁴, Jesse S Shapiro⁵, Vera Ignjatovic⁶, Michael Takagi⁷

Affiliations

¹ Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia. Electronic address: feiven.fan@mcri.edu.au.
² Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Psychology Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.
³ Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁴ Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia.
⁵ Murdoch Children's Research Institute, Melbourne, Victoria, Australia; School of Psychology, Deakin University, Geelong, Victoria, Australia.
⁶ Department of Paediatrics, University of Melbourne, Victoria, Australia; Institute for Clinical & Translational Research, Johns Hopkins All Children's, St Petersburg, FL, USA; Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁷ Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.

PMID: 38043751
DOI: 10.1016/j.neubiorev.2023.105498

Abstract

Post-traumatic headache (PTH) represents the most common acute and persistent symptom following concussion in children, yet the underlying pathophysiology remains unclear. This systematic review sought to: (i) rigorously examine the current evidence of PTH pathophysiology in paediatric concussion (0-18 years), (ii) assess the quality of evidence, and (iii) provide directions for future research in accordance with PRISMA guidelines. Eligible studies (n = 19) totalling 1214 concussion participants investigated cerebrovascular function (n = 6), white matter integrity (n = 3), functional connectivity (n = 3), electrophysiology (n = 1), neurometabolics (n = 2), biological fluid markers (n = 4), vestibular and oculomotor function (n = 4); two studies used a multi-modal approach. Majority of studies were rated as fair quality (90%) and Level 3 evidence (84%). The true underlying mechanisms of PTH following paediatric concussion remain unclear. Overall quality of the available evidence is generally weak with a fair risk of bias and characterised by relative scarcity and lack of specificity of PTH pathophysiology. Future research is required to rigorously isolate pathophysiology specific to PTH with strict adherence to clinical definitions and standardised measurement tools of PTH.

Keywords: Concussion; Mild traumatic brain injury; Paediatric; Persisting post-concussive symptoms; Posttraumatic headache.

Publication types

Systematic Review
Review

MeSH terms

Brain Concussion* / complications
Brain Concussion* / diagnosis
Child
Humans
Post-Traumatic Headache* / diagnosis
Post-Traumatic Headache* / etiology